Chapter 5 102 Although engagement with the content was optional, we integrated persuasive gamification elements to encourage interaction (A.5). Completed messages are collected in a “done pile”, visualized as a travel bag, that symbolized progress. Achieving the fillgoals of this bag is rewarded with aesthetic upgrades (A.4), encouraging short-term goal attainment (A.1). In addition, we included a reminder notification in case of inactivity to prompt adherence (A.2). The intervention also provides contact information for technical support (A.14). To translate the concept into a working functional prototype that could be formatively evaluated, we worked together with a software development agency to develop the back-end functionality of the intervention. In addition, a trained user experience designer developed the front-end visual style and layout of the prototype to ensure good usability (A.15). 5.2.2.5 Phase three: Formative evaluation of intervention We used the prototype to evaluate the acceptability of the intervention using a mixed methods approach. Quantitative measures were used to evaluate usability, user experience and perceived impact on the previously identified needs, while qualitative feedback was gathered to provide deeper insights into these constructs. The evaluations were performed individually with patients with a low SEP and took place at the same facility where they had their training sessions. The evaluations took approximately 45 minutes and were audio-recorded. We started with explaining the prototype, followed by instructing the participant to perform three key tasks within the interface. After this, we asked the participants to fill in short questionnaires about usability (based on the NASA TLX questionnaire (Hart, 2006)), user experience (containing usefulness and satisfaction based on the USE questionnaire (Lund, 2001)), and perceived impact of the intervention (designed for the purpose of this study and based on the previously identified needs) on a five-point Likert scale. After filling in the questionnaires we asked the participant to shortly explain their scores. We kept the questionnaire and questions short to keep the evaluation simple for the participant (E.5). We descriptively analyzed the Likert scale responses, including median and interquartile range (IQR). We also classified the Likert scores as negative (1 or 2), neutral (3), or positive (4 or 5) for each item and calculated the percentages of participants within each classification. For the qualitative data, we first transcribed the audio-recordings followed by a thematic analysis using ATLAS.ti. 5.2.3 Ethics and data management This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Human Research Ethics Committee of Delft University
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